Children With PANS May Manifest POTS, 2022, Chan et al

[Andy]

Objectives: Pediatric acute-onset neuropsychiatric syndrome (PANS) is characterized by an abrupt-onset of severe psychiatric symptoms including OCD, anxiety, cognitive difficulties, and sleep issues which is thought to be a post-infection brain inflammatory disorder. We observed postural orthostatic tachycardia syndrome (POTS) which resolved with immunomodulation in a patient with Pediatric acute-onset neuropsychiatric syndrome (PANS). Here, we aim to present a case of POTS and to examine the prevalence of (POTS) in our PANS cohort, and compare the clinical characteristics of patients with and without POTS.

Study Design: We conducted this cohort study of patients meeting PANS criteria who had at least three clinic visits during the study period. We included data from prospectively collected questionnaires and medical record review. We present a case followed by statistical comparisons within our cohort and a Kaplan-Meier analysis to determine the time-dependent risk of a POTS diagnosis.

Results: Our study included 204 patients: mean age of PANS onset was 8.6 years, male sex (60%), non-Hispanic White (78%). Evidence of POTS was observed in 19/204 patients (9%) with 5/19 having persistent POTS defined as persistent abnormal orthostatic vitals, persistent POTS symptoms, and/or continued need for pharmacotherapy for POTS symptoms for at least 6 months). In this PANS cohort, patients with POTS were more likely to have comorbid joint hypermobility (63 vs 37%, p = 0.04), chronic fatigue (42 vs 18%, p = 0.03), and a family history of chronic fatigue, POTS, palpitations and syncope. An unadjusted logistic regression model showed that a PANS flare (abrupt neuropsychiatric deterioration) was significantly associated with an exacerbation of POTS symptoms (OR 3.3, 95% CI 1.4–7.6, p < 0.01).

Conclusions: Our study describes a high prevalence of POTS in patients with PANS (compared to the general population) and supports an association between POTS presentation and PANS flare within our cohort.

Open access, https://www.frontiersin.org/articles/10.3389/fneur.2022.819636/full

 

[rvallee]

Not entirely convinced of the full validity of a full resolution:

POTS was considered resolved when the patient had normal orthostatic vitals and no POTS symptoms.

Coincidentally?

The POTS symptoms, abnormal orthostatic vitals, psychiatric symptoms, and central sleep apnea all resolved coincidentally with immunomodulatory therapies without the intervention of POTS specific therapies or changes in psychiatric medications.

This doesn't sound that coincidental:

If the association between inflammation and dysautonomia holds true, it may also explain why POTS resolved after the start of immunomodulatory therapies in the majority of our patients with POTS and PANS.

Anyway I was looking for what treatment they used and: IVIG.

 

[Ryan31337]

Anyway I was looking for what treatment they used and: IVIG.

This is one to keep an eye on: https://clinicaltrials.gov/ct2/show/NCT03919773

 

[Samuel]

i think it is entirely natural that if you have pans, you might also have pots. and spatulas.

lipkin and hornig and others did at least one paper on pandas [perhaps this: https://pubmed.ncbi.nlm.nih.gov/19668249/]. and i think hornig might have suggested at one point m.e. etiology could be similar.

in that paper something like: they injected mice with strep; the mice displayed ocd-like behaviors. injecting with strep antibodies caused issues with memory, social interactions, and more.

then removing the antibodies seemed to cause normal behavior. idk the status of the science, but i've read that humans with pandas do similar with staph infections. and that they display m.e.-like vigilance [wired but tired?]. [and add and anxiety.]

this area in general feels like it could in principle bring together neglected diseases possibly including m.e. and dysauto.

i'd like more treatments than ivig for scientists to try. scarce and not always tolerated.